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Hand Rashes, Dermatitis and the Healthcare Worker

Hand hygiene is a cornerstone of effective infection control in health care and social settings. Hand sanitization and gloving are essential if we are to stop the transmission of infection from body substances and contaminated articles in the environment. However, the frequent use of water, cleansing agents and gloves can cause irritation leading to dryness, inflammation, discomfort or unsightly appearance. Complicating the situation is the fact that health care workers are less likely to comply with hand hygiene policies when their hands are irritated but abraded skin can harbor more bacteria than normal hands. Understanding the nature and prevention of this condition can help healthcare workers take care of their skin while maintaining safe practices.

Hand dermatitis is common among healthcare workers, particularly those that work in patient care units where frequent hand washing or sanitizing is necessary. The most common symptoms are dry, red hands with cracks and fissures when the dryness is severe. Rash, either hives or red streaks or papules may be present, particularly if the rash is allergic in nature. There are three main types of hand dermatitis in the healthcare setting; irritant, allergic non-latex, and latex allergy.

Latex allergy is a specific allergy to natural rubber (from the rubber tree; not synthetic "latex" as in latex paint). More information on latex allergy, recognition and treatment, can be found at on the U-M OHS website. Allergic, non-latex dermatitis, is a type of contact dermatitis, similar to poison ivy,that can be caused by sensitivity to some of the non-rubber components of latex gloves. Since latex gloves have been phased out of use in our Hospitals and Health Centers, these conditions should not be an issue. By far, the most common type of hand dermatitis in healthcare workers is irritant; caused by frequent hand washing. Water alone or with cleansing agents can be irritating to hands by drying out the lipid layer of the skin. Forceful drying of wet hands with rough paper or cloth towels can also contribute to irritation. Powdered gloves are also drying but powdered non-sterile gloves should not be used. Putting on and taking off gloves can also be irritating, particularly if the glove is very form fitting and the hands are not dried sufficiently. Individuals who are prone to dry skin, eczema or other allergic skin conditions are likely to be more affected by frequent hand washing. Cold weather or dry environments are also hard on the hands.

Safe Hand Hygiene

Use alcohol gels when hands are not visibly soiled or if C. difficile is not an issue. Although alcohol may be perceived as a harsh chemical, alcohol based skin sanitizers are gentler on hands than soap and water because handwashing with soap and water involves friction from drying or irritation from chronically damp hands if they are not dried well.

When soap and water is required, use warm, not hot, water.

If the soap available in your area seems harsh or drying, contact U-M OHS or Infection Control Services. (UMHS hand washing soaps must conform to infection control standards; the most gentle product that meets the antimicrobial standards is chosen) Use the minimum amount of product necessary for effective cleansing.

Frequent use of moisturizers is essential to avoiding dermatitis or healing rough hands. Moisturizers must be used in approved containers to avoid contamination. Containers must be 16 oz or less and either a pump container or single person containers must be used.

Try the different gloves that are available in your area to see what type feels best. Using the largest glove size that will still conform sufficiently to allow dexterity will be least irritating from pulling on and off.

If your hands become dry or irritated, moisturizing while sleeping is very helpful. Apply moisturizer thickly and place thin cotton gloves over the moisturizer. Vaseline (petroleum jelly) is effective and inexpensive.

In cold or windy outdoor conditions, insulating gloves should be worn.

If irritation persists or if you develop cracking, fissuring or weeping, come to U-M OHS for further evaluation and treatment.